CASH

RECEIPT

PT. Genomik Solidaritas Indonesia (GSI Lab) DATE

Office:   Graha Mitra, 4th floor March 10, 2021, 4:09 p.m.
        Jl. Jend. Gatot Subroto Kav.21, Jakarta 12930
CASH RECEIPT NO.
Lab:    Jl. RA. Kartini No. 34, Cilandak, Jakarta 12430 1GYRDYZRQL2P1/PDI-100-031-
2982/GSI/III/2021
www.gsilab.id
BOOKING ID
ILJ-221-309-5487

PATIENT NAME
Dimas Ramdani Triputra

EMAIL
dimas.ramdani@zuperdrive.com

Description Quantity Unit Price Amount

PCR Tests H+1 (hasil keesokan hari maks. jam 23.59) _COVID 19 1 Rp. 699.000 Rp. 699.000

Total Rp. 699.000

This receipt is automatically generated by the system hence no signature is required